Pleural fluid characteristics of pleuropulmonary paragonimiasis masquerading as pleural tuberculosis.
10.3904/kjim.2015.30.1.56
- Author:
Ki Eun HWANG
1
;
Hyo Yeop SONG
;
Jae Wan JUNG
;
Su Jin OH
;
Kwon Ha YOON
;
Do Sim PARK
;
Eun Taik JEONG
;
Hak Ryul KIM
Author Information
1. Department of Internal Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea. kshryj@wonkwang.ac.kr
- Publication Type:Original Article ; Research Support, Non-U.S. Gov't
- Keywords:
Pleuropulmonary paragonimiasis;
Tuberculosis, pleural
- MeSH:
Adolescent;
Adult;
Aged;
Animals;
Biological Markers/analysis;
Child;
Child, Preschool;
Diagnosis, Differential;
Enzyme-Linked Immunosorbent Assay;
Eosinophilia/diagnosis/parasitology;
Female;
Glucose/analysis;
Humans;
L-Lactate Dehydrogenase/analysis;
Lung Diseases, Parasitic/*diagnosis/metabolism/parasitology/radiography;
Male;
Middle Aged;
Paracentesis;
Paragonimiasis/*diagnosis/metabolism/parasitology/radiography;
Paragonimus westermani/*isolation & purification;
Pleural Effusion/*diagnosis/metabolism/parasitology/radiography;
Predictive Value of Tests;
Retrospective Studies;
Tomography, X-Ray Computed;
Tuberculosis, Pleural/*diagnosis;
Young Adult
- From:The Korean Journal of Internal Medicine
2015;30(1):56-61
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND/AIMS: Pleuropulmonary paragonimiasis produces no specific symptoms or radiologic findings, allowing for the possibility of misdiagnosis. We evaluated the specific clinical and pleural fluid features of pleuropulmonary paragonimiasis masquerading as pleural tuberculosis. METHODS: We retrospectively analyzed the clinical and radiologic characteristics of 20 patients diagnosed with pleuropulmonary paragonimiasis between 2001 and 2011. RESULTS: In total, 17 patients presented with respiratory symptoms, including dyspnea (30%), hemoptysis (20%), cough (20%), and pleuritic chest pain (15%). Chest radiographs revealed intrapulmonary parenchymal lesions, including air-space consolidation (30%), nodular opacities (20%), cystic lesions (15%), ground-glass opacities (10%), and pneumothorax (5%). A pleural f luid examination revealed eosinophilia, low glucose levels, and high lactate dehydrogenase (LDH) levels in 87%, 76%, and 88% of the patients, respectively. These traits helped to distinguish pleuropulmonary paragonimiasis from other pleural diseases such as parapneumonic effusion, malignancy, and pleural tuberculosis. CONCLUSIONS: Pleuropulmonary paragonimiasis is often initially misdiagnosed as other pleural diseases. Therefore, it is important to establish the correct diagnosis. In patients with unexplained pleural effusion living in paragonimiasis-endemic areas, pleural fluid obtained by thoracentesis should be examined to distinguish pleuropulmonary paragonimiasis. When marked eosinophilia, high LDH levels, and low glucose levels are identified in pleural fluid, physicians could consider a diagnosis of pleuropulmonary paragonimiasis.
